2015 Aboriginal Health Access Centres Report

(1)

(2)

unique in Canada and made in Ontario, AHACs are community-led, primary health care organizations. They provide a comprehensive array of health and social services to Aboriginal peoples across the province. These services include: primary care, traditional healing, mental wellness, cultural programs, health promotion programs, community development initiatives and social support services.

AHACs approach health and wellbeing in a wholistic way, providing not only clinical services, but also community designed teachings, languages, medicines and ceremonies.

For AHACs, culture is treatment. Through this approach, AHACs have earned trust and credibility in the

communities they serve.

Because of increasing demand for services and programs, the AHACs grew from 1995-2005. By 2005, it was clear that the demand for services

outpaced funding levels. Continuing to the present day, wait lists grow and centres struggle. The core health funding inequities AHACs face in relation to their Community Health Centre (CHC) counterparts are crippling. Some progress has been made toward funding parity as the result of rigorous advocacy over many years. However, major inequities continue and funding parity is crucial for the AHACs’ success. despite these challenges, AHACs reconnect Aboriginal peoples with the practices, sense of community and cultures that were taken away through the course of centuries. AHACs are community health spaces that offer a sense of belonging. As spaces of respect, truth, humility, honesty, courage, love and wisdom, AHACs are making a difference to healing, health and wellbeing among Aboriginal communities across Ontario.

AHACs recognize the need to expand Aboriginal health in the province of Ontario. The AHACs work in parallel to the collective efforts of the grass roots people, leaders and health custodians in their efforts to gain equitable access to health care, respectful of cultural inclusion.

“HeAlTH CARe SeRVICeS FOR ABORIGInAl

PeOPle MuST Be PlAnned, deSIGned And

deVelOPed By ABORIGInAl PeOPle And

Be AVAIlABle In lOCATIOnS IdenTIFIed By

FIRST nATIOn/ABORIGInAl COMMunITIeS.

THeSe PROGRAMS And SeRVICeS MuST

ReSPeCT, ACCePT And InCORPORATe

ABORIGInAl VAlueS And BelIeFS And

MuST Be FlexIBle In ORdeR TO SuPPORT

CulTuRAlly-SPeCIFIC APPROACHeS TO

COMMunITy HeAlTH...”

(5)

5 AHAC Sector in a Snapshot

2 _{This count is based on clients with and without Ontario Health Insurance Plan (OHIP).}

3_{There are 133 First Nations communities in Ontario. It was determined that the AHACs provide service to at least one or more clients from approximately 106 different communities. At the time when the analysis was conducted there was no mechanism to determine which community(ies)}

use AHAC programs and services the most.

Female Male undisclosed 55% 42% 3% Gender distribution of AHAC Clients in 2014 13.32% 14.93% 42.35% 24.74% 4.64% Age distribution of AHAC Clients in 2014 Children 0-9 youth: 10 to 19 Adults: 20 to 49 elders: 50+ undisclosed

About

half

of the AHACs

serve non-insured clients.

AHACs provide health services in the following languages:

Oji-Cree, Cree,

Inuktitut, Iroquois, Mohawk, Ojibway, sign language

.

AHACs provide an

interprofessional circle of care

with providers as

diverse as clinicians, mental health providers, traditional healers using a common

electronic Medical Record (eMR), which is nightingale on demand (nOd).

Approximately 80%

of the

First nations communities in Ontario

have had First nations members

access AHAC services.

About

a third of those

served

are in the centres’ catchment areas.

3

In 2014, AHACs served

over 50,000

Aboriginal people in Ontario.

2

(6)

Aboriginal People

in Ontario

Source: Ministry of Aboriginal Affairs, 2014 First nations Reserves Settlements

First Nations

and Treaties

Adhesion to Treaty 9, 1929 Treaty 9, 1905-1906 Treaty 5, 1875 Treaty 3, 1873 Treaty 60, 1850 (Robinson-Superior) Treaty 61, 1850 (Robinson-Huron) Treaty 11, 1798 Treaty 45, 1836 Treaty 94, 1862 Treaty 72, 1854 Treaty 45 1/2, 1836

Williams Treaty with the Mississauga, 1923 Treaty 18, 1818 Treaty 16, 1815 Treaty 20, 1818 Treaty 19, 1818 Treaty 29, 1827 Treaty 6, 1796 Treaty 21, 1819 Treaty 7, 1796 Treaty 2, 1790 Treaty 35, 1833 Treaty 3, 1792 Treaty 381, 1781 Treaty 4, 1793 Treaty 3 3/4, 1795 Treaty 13A, 1805Treaty 13, 1805

Joh nson-Butler Purchases 1787-1788/ Williams Treaties 1923 Treaty 3 1/2, 1793 Treaty 57, 1847 Treaty 27, 1819 Crawford’s Purchases 1783 Joh n Collins’ Purchase 1785

The urban Aboriginal population

in Ontario is

150,565

.

Source: Ontario Federation of Indigenous Friendship Centres, 2014

According to the 1991 Aboriginal People’s Survey,

22%

of Aboriginal adults in Ontario reported having

changed

communities

at least once in their lifetime, with Ontario’s

level of off-reserve migration being the highest in Canada.

Source: Canadian Encyclopedia, Urban Migration of Aboriginal People, 2011

Ontario’s Aboriginal population

increased by 24.3%

between 2006 and

2011, compared with 4.8% for the non-Aboriginal population.

Source: Ontario Ministry of Finance, National Household Survey Highlights. Fact sheet 3, 2011

Ontario is the province where the largest

number of Aboriginal people live,

301,425

people, representing 21.5% of the total

Aboriginal population in Canada.

(7)

7 Ontario

ANISHNAWBe MuSHkIkI

mAin oFFice: THundeR BAy

cAtcHment AreA:

THundeR BAy And AReA _{mAin oFFice:}N’MNINOeyAA_CuTleR

cAtcHment AreA:

nORTH SHORe OF lAke HuROn, BeTWeen SudBuRy

And SAulT STe. MARIe, AlOnG HIGHWAy 17 And THe

CITy OF SAulT STe. MARIe

NOOJMOWIN Teg

mAin oFFice: AundeCk OMnI kAnInG FIRST nATIOn

cAtcHment AreA:

MAnITOulIn ISlAnd, WHITeFISH RIVeR, eSPAnOlA

And SeVen FIRST nATIOnS

gIzHeWAADIzIWIN

mAin oFFice:

FORT FRAnCeS

cAtcHment AreA:

RAIny RIVeR dISTRICT, FORT FRAnCeS, eMO, RAIny RIVeR

MOHAWk COuNCIL OF AkWeSASNe mAin oFFices: AkWeSASne OnTARIO cAtcHment AreA: AkWeSASne, OnTARIO AkWeSASne, QuéBeC AkWeSASne, neW yORk

WABANO CeNTRe FOR ABORIgINAL HeALTH

mAin oFFice: OTTAWA

cAtcHment AreA:

nATIOnAl CAPITAl ReGIOn

De DWA DA DeHS Nye>S

mAin oFFice: HAMIlTOn

cAtcHment AreA:

BRAnTFORd, HAMIlTOn WITH OuTReACH TO THe nIAGARA

ReGIOn

SOuTHWeST ONTARIO ABORIgINAL HeALTH

ACCeSS CeNTRe (S.O.A.H.A.C)

mAin oFFice: lOndOn

cAtcHment AreA: lOndOn, CHIPPeWAS OF THe THAMeS,

WIndSOR, OWen SOund

AHACs in

Ontario

WAASegIIzHIg NANAANDAWe’IyeWIgAMIg centrAl service locAtion: kenORA

cAtcHment AreA: dAlleS, GRASSy nARROWS, nORTHWeST

AnGleS (nO. 33, And nO. 37), WASHAGAMIS BAy, SHOAl

lAke And ISkATeWIzAAGeGAn, WHITedOG, WHITeFISH BAy, RAT PORTAGe, kenORA, MInAkI,

WABIGOOn

SHkAgAMIk-kWe

mAin oFFice: SudBuRy

cAtcHment AreA:

CITy OF GReATeR SudBuRy, WAHnAPITAe, HenVey InleT,

(8)

AHACs operate from a wholistic

Aboriginal health framework.

Recognizing Aboriginal rights to

self-determination in health, the framework

focuses on the restoration and

rebalancing of the physical, mental,

emotional and spiritual wellbeing

of Aboriginal peoples, families,

communities and nations.

With individuals and families at the centre, the framework incorporates Aboriginal traditional healers and healing approaches, prevention and promotion community programs,

culturally safe primary care, and effective administration and community governance. due to its vital importance, mental wellness is addressed in many quadrants, including traditional, community programs and primary care. Through this framework, AHACs strive to address the comprehensive continuum of care from promotion and prevention to treatment and rehabilitation, through all the stages of life from pre-natal to elder. The framework also recognizes the importance of the interconnectedness of people, nature and the spirit world. Culture surrounds all that AHACs do.

In the following pages, you will find more information about the work that AHACs do following the four cardinal points of the medicine wheel.

The AHAC Framework

CulTuRAl

PRACTICe IS key,

AS ReFleCTed

THROuGH THe

TeACHInGS OF THe

MedICIne WHeel

And THe FOuR

dIReCTIOnS OF

CReATIOn.

Core

IndIVIduAlS & FAMIlIeS

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

(9)

9 Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

COMMunITy PROGRAMS

Traditional programs are the foundation

for healing in AHACs, who offer Aboriginal

traditional healing services delivered by

elders, healers, medicine people, helpers.

Between 2013 and 2014,

over

30,000

Aboriginal and non-Aboriginal

clients were seen by the AHACs for

traditional programs.

Here are a few examples of

traditional healing

services:

• Storytelling

• Ceremonies, including:

• seasonal

• rites of passage

• healing

• sweat lodges

• Feasts

• Traditional arts and crafts

• drumming

• dancing

• Traditional teachings

• Circles,including:

• teaching

• talking

• healing

• Traditional medicines, doctoring, counselling,

one-to-one visits, medicine walks

Traditional: Creating a Place of Healing

and Belonging Where Culture Is Treatment

(10)

Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

COMMunITy PROGRAMS

The AHAC sector offers

the following wholistic

community

programs

to build

healthy communities,

families and people:

• Mental wellness • Trauma-based therapies • Senior’s physical activity • Frail seniors

• Senior’s social isolation • Childhood physical activity • Childhood nutrition • Healthy babies • early years • Housing • Food security • Harm reduction • Concurrent disorders • Homelessness • Oral health screening • Tobacco/smoking cessation

• Cultural programming • Workplace safety • education

• Fetal Alcohol Spectrum disorder (FASd)

• diabetes education

• Chronic disease management • Rehabilitation services

• On-reserve Aboriginal personal development groups (PdGs) • Healthy choices

• Choices Program for youth at risk

• Parent support programming • Community kitchens

Community Programs:

(11)

1 1

Primary Care:

Culturally Competent

Primary Care within an

Aboriginal-Specific Model

Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

COMMunITy PROGRAMS

The AHACs had

over 102,000

clinical

encounters per year.

4

Over 20,000

unique clients accessed

primary care services since the transition to

nightingale on demand (nOd).

5

6.72 is the average number of visits per

client per year.

6

4,570

clients had more than 10

encounters per year.

7

The

top reasons

for clients accessing

primary care services:

• diabetes (Type II) • Mental health • Hypertension • Well care

Training and supervision of clinical

providers

ensure culturally

competent primary care,

furthering the journey to cultural safety.

Most AHACs also provide

home and

community visits

for primary care.

The clients that they typically see are:

• Frail seniors

• Those requiring palliative/end-of-life care • Those with mental health problems • Those with a disability

• Isolated/remote

In 2014, about 75% of AHACS offered

advanced access

.

4_{Between 2013 and 2014. As AHACs went live on NOD at different times, it means that some of them had more available data than others for the above-mentioned timeframe.}

5_{Between 2013 and 2014. Also, AHACs had different transition times to NOD throughout 2013; last AHAC completing transition towards end of January 2014.}

6 _{Between 2013 and 2014. 6.72 represents the total number of encounters divided by number of unique clients served in the last year.}

7 _{Between 2013 and 2014.}

(12)

Administration:

Interconnected and

Interdependent

Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

COMMunITy PROGRAMS

• Ministry of Health and long-Term Care (MOHlTC) • local Health Integration networks (lHIns) • Ministry of Children and youth Services (MCyS) • Ministry of Community and Social Services (MCSS) • Aboriginal Healing and Wellness Strategy (AHWS) • Federal government (Health Canada)

• Band councils

• Health Force Ontario (HFO) • Health Quality Ontario (HQO)

• Ontario Federation of Indian Friendship Centres • Municipalities

• Health links

• Community Care Access Centres (CCACs) • Public health units

• Ontario Trillium Foundation (OTF) • Social Planning and Research Council • Right to Play International

• local and regional hospitals

• Aboriginal Community Health Centres (CHCs) – Anishnawbe Health Toronto, Misiway Milopemahtesewin and Chigamik • Association of Ontario Health Centres (AOHC)

• Cancer Care Ontario (CCO)

• Canadian Centre for Accreditation (CCA) • School boards

• Civic organizations (service clubs) • Charitable organizations

• Community foundations • Food security organizations

AHACs have partnerships with:

On average, the base funding that an AHAC receives is

in the area of $2M.

Over 250 volunteers contributed with over 15,000 hours of service in the AHACs between 2013 and 2014.

Some of the AHACs are already accredited by the Canadian Centre for Accreditation. The whole sector is working towards accreditation.

The majority of AHACs have processes to assess client experiences.

Most of the AHACs have mechanisms in place to obtain input from caregivers regarding clients’

(13)

1 3

Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

COMMunITy PROGRAMS

Individuals and Families: Creating a Place of

Healing and Belonging Where Our Voices

Are Heard

At the

core of the circle

are the individuals and families we are committed to serving. All quadrants of the circle work

together in building healthy communities.

(14)

Very genuine, kind, and caring. Health practitioners get to

the root of the problem instead of just offering band aid

solutions.

What AHAC clients are saying about service quality, service coordination and culture in these organizations.

The nurses are awesome; very friendly, compassionate,

and thorough.

They are in the community so we have easy access to

their services.

They are always here when I need them!

everything I needed, they took care of.

Mix of non-native and Anishinaabe ways, respectful of

both workers.

Traditional Healing is done really well.

Outreach services to the First nations is successful.

Fn people can’t afford to go

to kenora. Having Fns people

working with their own is a

strength. Proud of the people

that are educated in the

medical field.

It’s good to know Anishinaabe are helping one another for

services.

We are very grateful and pleased with the service provided.

I felt comfortable talking to you because it helps me heal.

Thank you so much for everything. your staff are

amazing to me and my daughter.

you are doing an excellent job. It’s about time Aboriginal

needs are met in our own unique element! Miigwetch!

Core

North

AdMInISTRATIOn

West

PRIMARy CARe

East

TRAdITIOnAl

South

(15)

1 5

Our Seventh Generation,

Our Future

1 5

We are collectively working

toward a self-determined,

independent future – free

from addictions and avoidable

illness – in which all Aboriginal

people feel able to achieve

their full potential. This will be

enhanced when we receive

equitable funding, and

recognition that culture is

healing – that our ways

of knowing and doing

are equal to those of all

other nations.

(16)

Association of Ontario Health Centres (AOHC) Association des centres de santé de l’Ontario (ACSO) 970 lawrence Ave. West, Suite 500

Toronto, Ontario M6A 3B6

www.aohc.org/aboriginal-health-access-centres

2015 Aboriginal Health Access Centres Report

Table of Contents

3

4

5

6

7

8

9

10

11

12

13

14

15

The Genesis of Aboriginal Health Access Centres (AHACs)

Introduction to the AHACs

AHAC Sector in a Snapshot

Aboriginal People in Ontario

AHACs in Ontario

The AHAC Framework

east – traditional: Creating a Place of Healing and Belonging Where Culture

is Treatment

south – community programs: Helping Rebuild Our Communities

West – primary care: Culturally Competent Primary Care within an

Aboriginal-Specific Model

north – Administration:

Interconnected and Interdependent

core – individuals and Families:

Creating a Place of Healing and Belonging

Where Our Voices Are Heard

core – individuals and Families: Voices Heard

Our Seventh Generation, Our Future

3

The Genesis of Aboriginal Health Access Centres

In 1994, the Province of Ontario initiated

the Aboriginal Healing and Wellness

Strategy (AHWS) to promote healing

and health among Aboriginal

people as

a commitment to address the alarmingly

poor health and high incidence of family

violence resulting from colonialism.

AHWS RelIed

On TWO key

COnCePTS:

HeAlInG And

Introduction to the AHACs

Ontario’s ten Aboriginal Health

Access Centres were founded to

address the impacts of colonization

and inter-generational trauma and

play a powerful role in the healing,

health and wellbeing of Aboriginal

peoples in Ontario.

“HeAlTH CARe SeRVICeS FOR ABORIGInAl

PeOPle MuST Be PlAnned, deSIGned And

deVelOPed By ABORIGInAl PeOPle And

Be AVAIlABle In lOCATIOnS IdenTIFIed By

FIRST nATIOn/ABORIGInAl COMMunITIeS.

THeSe PROGRAMS And SeRVICeS MuST

ReSPeCT, ACCePT And InCORPORATe

ABORIGInAl VAlueS And BelIeFS And

MuST Be FlexIBle In ORdeR TO SuPPORT

CulTuRAlly-SPeCIFIC APPROACHeS TO

COMMunITy HeAlTH...”

5

AHAC Sector in a Snapshot

About

half

of the AHACs

serve non-insured clients.

AHACs provide health services in the following languages:

Oji-Cree, Cree,

Inuktitut, Iroquois, Mohawk, Ojibway, sign language

.

AHACs provide an

interprofessional circle of care

with providers as

diverse as clinicians, mental health providers, traditional healers using a common

_{people as}